JT Property Wash

• Job Number

• Wash Location

• Site Address

• Wash date

  Date

• Contractor

• Description of Work

• DoL Number

POTENTIAL HAZARDS

Arrival on site, Induction and Set up

• People

  YES

  NO

• Safety Control: Cone off truck and initial work area and display Hazard Board.

Building wash / Gutter clear / Roof treatment

USE OF WATERBLASTER

• Noise - damage to hearing?

  YES

  NO

• Safety Control: Use of noise eliminating ear muffs.

• Spray back into eyes

  YES

  NO

• Safety Control: Use of eye protection glasses.

• Chemical Burns

  YES

  NO

• Safety Control: Wearing of gloves while handling, and handling as per MSDS sheets. (Competent Operator).

ON SITE HAZARDS

• Electrical points

  YES

  NO

• Safety Control: Look for all electrical points of contact, if unsure if weatherproof then avoid altogether.

• Working at height

  YES

  NO

• Safety Control: Harnesses to be used where possible and working with spotter. Portable scaffolding and access machinery to be used for any areas that are unsafe. All operators trained in Height & Harness work.

• People

  YES

  NO

• Safety Control: Cone off truck and final work area and display Hazard Board.

CHEMICALS

• Burns

  YES

  NO

• Safety Control:
  - Always wear your PPE gear when handling chemicals and use as per MSDS specifications.
  - Chemicals diluted further to mitigate chemical burns.
  - Current work area coned off and hazard board displayed
  

Job completion, pack up and depart

• People

  YES

  NO

• Safety Control: Cone off truck and final work area and display Hazard Board.

Take 5

• Before the job starts Take 5 to check for any additional Hazards
  
  

• Have you conducted a formal Take 5 of the job prior to work commencing

  YES

  NO

• Are there any additional hazards?

• What are the Safety Controls for these hazards?

• If any hazards were found, Have you informed the Site Manager?

  YES

  NO

  N/A

• On Site Contact

• Contractor to sign:

  Sign

Tools, Equipment & Training required for this work

• Is the work OSH notifiable?

  YES

  NO

• IF YES: Has MoBIE (Ministry of Business, Innovation & Entreprise) been notified and permits completed?

  YES

  NO

  N/A

• Is any Plant Machinery required?

  YES

  NO

• IF YES: Are qualifications / Licences current to operate?

  YES

  NO

  N/A

• In addition to the above, have all pre start checks been completed?

  YES

  NO

  N/A

• Is any Specialist Equipment required?

  YES

  NO

• IF YES: Are qualifications / training current if required?

  YES

  NO

  N/A

• Are any Electrical tools required?

  YES

  NO

  N/A

• IF YES: Are they currently test tagged and in date?

  YES

  NO

  N/A

Personal Protective Equipment to be used on this job

• PPE required for this job? If NO then Why?

  Yes

  No

• PPE Safety Glasses

  YES

  NO

• PPE Gloves

  YES

  NO

• PPE Hearing Protection

  YES

  NO

• PPE Footwear

  YES

  NO

• High Vis Clothing

  YES

  NO

• Harness

  YES

  NO

• Cones / Barriers

  YES

  NO

• CAUTION Signs

  YES

  NO

• Ladders

  YES

  NO

• Drain Socks

  YES

  NO

• Drain Covers

  YES

  NO

ROOF

• Paint Condition

  GOOD

  FAIR

  POOR

• Flashings

  GOOD

  FAIR

  POOR

• Rust

  YES

  NO

• Moss / Lichen

  YES

  NO

• Secure ladder tie off points identified?

  YES

  NO

• Roof hatch hinged?

  YES

  NO

• Are they safe in high winds?

  YES

  NO

• Anchor lines on roof?

  YES

  NO

• Additional anchor lines required?

  YES

  NO

• Anchor lines tagged?

  YES

  NO

• Slipper walk ways?

  YES

  NO

• Any clear lite sheets / asbestos?

  YES

  NO

• Vent guards used

  YES

  NO

• Identify Hazards on Roof

GUTTERS / DOWNPIPES

• Debris

  YES

  NO

• Ponding water

  YES

  NO

• Rust

  YES

  NO

BUILDING

• Paint condition

  GOOD

  FAIR

  POOR

• Rust

  YES

  NO

• IF YES: Where?

• Graffiti

  YES

  NO

• Slippery walk ways

  YES

  NO

• Spider / Bird Issues

  YES

  NO

• Damaged areas including cracks & dents

  YES

  NO

• Possible weather tight issues?

  YES

  NO

• Loading dock way

  GOOD

  FAIR

  POOR

• Canopies - Condition

• Entrance Paving - Condition

• Has waste water entered a drain?

  YES

  NO

• Was access equipment used?

  YES

  NO

  N/A

• IF YES: Who was the supplier?

• Hours on site

• Injury / Incidents on site?

  Select NONE NEAR MISS MINOR SERIOUS

  • NONE
  • NEAR MISS
  • MINOR
  • SERIOUS

• Photos (Before)

  Media

• Photos (After)

  Media

• Comments

• Does the client have any issues?

  NO

  YES

• Site Contact

  Sign

• JTPW Contractor

  Sign